CEDI News: COBA and Affiliated National Provider Identifier (NPI) Process Modifications

COBA and Affiliated National Provider Identifier (NPI) Process Modifications

Attention: Medicare Part A, Part B and DME MAC electronic submitters, software vendors, billing services and clearinghouses.

Effective October 6, 2008, Medicare will reject all incoming Medicare electronic claims that contain any legacy provider identifiers (qualifiers) other than the following:

NPI (NM109 segment using the qualifier “XX”)
EIN/Federal Tax ID (using the qualifiers “EI” or “TJ” within the secondary provider REF loops)
SSN (using the qualifier “SY” within the secondary provider REF loops)

The secondary provider REF loops in American National Standards Institute (ANSI) are: 2010AA, 2010AB, 2310A, 2310B, 2310C, 2310D, 2310E, 2330D, 2330E, 2330F, 2330G, 2330H, 2420A, 2420B, 2420C, 2420D, 2420E and 2420F. Medicare will not accept qualifiers other than “EI”, “TJ” or “SY” in these secondary provider loops beginning with electronic claims accepted on or after October 6, 2008.

NOTE: The secondary provider REF loops listed above should only be used for Medicare claims when appropriate for the line of business submitted. The qualifiers (“EI”, “TJ” and “SY”) should only be used when valid for the loop submitted.

All loops and qualifiers referenced are part of the ANSI format. Providers and suppliers that have questions regarding these loops and/or qualifiers should contact their software vendor for further details.

NOTE: This article is written in reference to CMS Change Request 6024, Transmittal 1507, titled, “Coordination of Benefits Agreement (COBA) and Affiliate National Provider Identifier (NPI) Process Modifications.”

Post Date 09/25/08